Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
Division of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Japan.
World J Surg. 2024 Mar;48(3):568-573. doi: 10.1002/wjs.12072. Epub 2024 Jan 19.
In the early 2000s, substantial variations were reported in the management of pediatric patients with blunt splenic injury (BSI). The purpose of this study was to assess the recent trends and disparities between different types of trauma centers. We hypothesized that there would be persistent disparities despite decreased trends in the rate of splenectomy.
This is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database. We included patients (age ≤18 years) with high-grade BSI (Abbreviated Injury Scale 3-5) between 2014 and 2021. The patients were divided into three groups based on trauma center types (adult trauma centers [ATCs], mixed trauma centers [MTCs], and pediatric trauma centers [PTCs]). The primary outcome was the splenectomy rate. Logistic regression was performed to evaluate the association between trauma center types and clinical outcomes. Additionally, the trends in the rate of splenectomy at ATCs, MTCs, and PTCs were evaluated.
A total of 6601 patients with high-grade BSI were included in the analysis. Overall splenectomy rates were 524 (17.5%), 448 (16.3%), and 32 (3.7%) in the ATC, MTC, and PTC groups, respectively. ATCs and MTCs had significantly higher splenectomy rates compared to PTCs (ATCs: OR = 5.72, 95%CI = 3.78-8.67, and p < 0.001 and MTCs: OR = 4.50, 95%CI = 2.97-6.81, and p < 0.001), while decreased trends in the splenectomy rates were observed in ATCs and MTCs (ATCs: OR = 0.92, 95%CI = 0.87-0.97, and p = 0.003 and MTCs: OR = 0.92, 95%CI = 0.87-0.98, and p = 0.013).
This study suggested persistent disparities between different trauma center types in the management of children with high-grade BSI.
在 21 世纪初，报告了小儿钝性脾损伤（BSI）患者管理方面的显著差异。本研究的目的是评估不同类型创伤中心之间的最新趋势和差异。我们假设尽管脾切除术的比例呈下降趋势，但仍存在持续的差异。
这是一项使用美国外科医师学会创伤质量改进计划数据库的回顾性队列研究。我们纳入了 2014 年至 2021 年期间患有高级别 BSI（损伤严重程度评分 3-5）的患者（年龄≤18 岁）。根据创伤中心类型（成人创伤中心[ATC]、混合创伤中心[MTC]和儿科创伤中心[PTC]）将患者分为三组。主要结局是脾切除术率。采用逻辑回归评估创伤中心类型与临床结局之间的关联。此外，还评估了 ATC、MTC 和 PTC 脾切除术比例的变化趋势。
共纳入 6601 例高级别 BSI 患者。ATC、MTC 和 PTC 组的脾切除术率分别为 524 例（17.5%）、448 例（16.3%）和 32 例（3.7%）。ATC 和 MTC 的脾切除术率明显高于 PTC（ATC：OR=5.72，95%CI=3.78-8.67，p<0.001 和 MTC：OR=4.50，95%CI=2.97-6.81，p<0.001），而 ATC 和 MTC 的脾切除术率呈下降趋势（ATC：OR=0.92，95%CI=0.87-0.97，p=0.003 和 MTC：OR=0.92，95%CI=0.87-0.98，p=0.013）。
本研究表明，不同类型创伤中心在治疗高级别 BSI 儿童方面存在持续差异。
